Provider Demographics
NPI:1457425373
Name:GALLAGHER, NORMAN R (RPH)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:R
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 N ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1122
Mailing Address - Country:US
Mailing Address - Phone:845-856-3236
Mailing Address - Fax:
Practice Address - Street 1:10 SUSSEX ST # -12
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2421
Practice Address - Country:US
Practice Address - Phone:845-856-8314
Practice Address - Fax:845-856-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist